The California Department of Social Services (CDSS) Privacy Notice on Collection covers our practices regarding personal
information collected when completing forms (online or hardcopy) such as name, social security number, physical description,
home address, home telephone number, education or financial, medical or employment history, etc. Any personal information
collected is subject to the limitations in the following Federal and State policies:

CDSS collects personal information directly from individuals who volunteer to obtain some of our services. Collection of this
information is required to deliver the specific services, but use of these services is voluntary. Failure to provide requested
information may result in a denial of services.

The information collected will not be shared with any other Federal or State agencies, unless required by law.

Please do not provide personal information that is not requested. Any fields in the form with unrestricted text are intended for the requested information only.

Individuals who provide personal information to CDSS have the right to review the information for accuracy and completeness and to request corrections or
deletions. For information, review the online CDSS Privacy Policy Statement.

Individuals have the right to access records containing personal information. You may contact the Home Care Services Bureau by phone at
1-877-424-5778 or by email at
HCSB@dss.ca.gov.

For more consumer information on security please see the California Department of Justice’s
“Security Awareness”.

The Home Care Aide Registry uses Google Services to validate your physical and mailing address. Your browser may also prompt you to
allow your location information to be transmitted to Google. Sharing your location is NOT necessary for using the Google Services.

Refer to Google's privacy policy on how Google may use this information:

If you choose NOT to use Google Services to validate your address, no information will be transmitted to Google. There is NO penalty
for making this choice, and it will NOT affect your status on the Home Care Aide Registry.

Allow information to be transmitted to Google to validate your address?

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Your registration expires two years after your initial registration date. You must renew on or before your registration date and you may renew up to
90 days prior to expiration. If you do not renew, your Home Care Aide registration
will be forfeited. If you are not already registered as a Home Care Aide, please use the "Registration" link
above to submit an initial application.

To begin the renewal process, please enter your 10-digit Personnel ID (PER ID) number and your unique personal identification number (PIN) in the text
boxes below. To verify your identity, it is important that you enter the PER ID and PIN exactly as it appears on your renewal notice.

If you need to change your address, email address, or phone number, you may update this information after you enter your PER ID and PIN below. Please
note that all information collected on this form may be recorded by the California Department of Social Services.

If you lost your renewal notice or have problems during the online renewal process, please contact the Home Care Services Bureau at
1-877-424-5778 or by email
at HCSB@dss.ca.gov.
Please note that the online renewal process will allow you to renew your Home Care Aide registration immediately; therefore, it is highly recommended
you renew online.

Required fields are noted by the asterisk (*) and must be filled out in order to proceed.

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Thank you for taking the time to go through the Home Care Aide registration process to become listed on the Home Care Aide
Registry. To begin the registration process, complete the following information. The information will be
presented on different pages noted with the step numbers. There are eight (8) steps in total. Note that all
information collected during this process will be recorded on the CDSS servers.

Required fields are noted by the asterisk (*), and must be filled out in order to proceed.
All other fields are optional. Note that any fields that require special characters (such as dashes, slashes, and
parenthesis) are entered automatically. If you have any criminal background information to disclose, follow the instructions
located in the criminal background disclosure section on step four (4).

PER ID and PIN do not match. Please ensure you are entering the correct numbers. These numbers can be found in the upper right-hand corner of your renewal notice. If you continue to receive this error message,
please contact the Home Care Services Bureau at 1-877-424-5778.

You are outside the renewal window. Please renew within 90 days prior to your expiration date. If you are past your expiration date,
please click the ‘Registration’ link above to submit an initial application.

You are not in a Registered status. Therefore, you are unable to renew. If you believe you received this message in error, please contact the Home Care Services Bureau at
1-877-424-5778.

Step 4 of 8: Criminal Background Disclosure

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State law requires that persons associated with licensed facilities or are Home Care Aide Registry applicants to be
fingerprinted and disclose any conviction. A conviction is any plea of guilty or nolo contendere (no contest) or a verdict of guilty.
The fingerprints will be used to obtain a copy of any criminal history you may have.

You need not disclose any marijuana-related offenses covered by the marijuana reform legislation codified at Health and Safety
Code sections 11361.5 and 11361.7.

NOTE: IF THE CRIMINAL BACKGROUND CHECK REVEALS ANY CONVICTION(S) THAT YOU DID NOT DISCLOSE, THE CONVICTION(S)
MAY RESULT IN AN CRIMINAL RECORD EXEMPTION DENIAL, HOME CARE AIDE REGISTRY APPLICATION DENIAL, LICENSE APPLICATION DENIAL, LICENSE
REVOCATION, OR EXCLUSION FROM A LICENSED FACILITY/ORGANIZATION.

If you do not have any criminal history, go to Step 5

Have you ever been convicted of a felony or misdemeanor?
You need not disclose any marijuana-related offenses covered by the marijuana reform
legislation codified at Health and Safety Code sections
11361.5
and 11361.7

All entries to the offense section will be recorded and reviewed.
Do you have any offenses to disclose? *

I declare under penalty of perjury under the laws of the state of California
that I have read and understand the information contained in this section
and that my responses are true and correct

What was the offense?

In which city did the offense take place?

Which State?

When did the offense occur?
(250 characters remaining)

Describe this offense (500 characters remaining)

Enter the name of the offense (such as theft, petty theft, DUI)), the city and state where the offense took place, and the date the
offense occurred. You must also enter a brief (500 character maximum) description of the nature and circumstances of the offense.
If you have more than one offense to add, click the 'Add Offense' button to add the information to the record and complete the section
for the new offense again.

If you choose to delete an offense or edit an offense, click the 'Delete' button on the table entry below the form and add a new
offense if necessary. You may only add offenses on this page, and you may NOT go back and edit your offense once you leave this step.

Warning: You have indicated that you have no offenses to disclose, but have entered offenses. In order to
continue, you must delete all offenses you have entered, or select "I have offenses to disclose" from the drop down menu.